Back to the Future

Dermatology has changed so much during the past two decades. In truth, it looks entirely different than it did when I completed my residency and fellowship—and that wasn’t all that long ago. (At least, I’d like to think it wasn’t).

Paper charts have gone the way of dinosaurs. In their place, we now have Electronic Medical Records (EMRs) that can increasingly communicate with one another across health systems, and growing numbers of patients see their dermatologist virtually to diagnose, treat, and monitor their skin conditions.

And this is just the beginning. As far as what we can expect, predicting the future is a fool’s game, but here it goes, anyway. (Spoiler alert: it’s not bleak or Orwellian.)

Innovations on the Horizon

Imaging. Instead of a dermatoscope, we will increasingly sport smart glasses or contacts that can capture images of lesions and send these images for analysis with one click or even a wink. Thanks to augmented intelligence, the images will be compared via algorithms to let us know if the growth is benign or needs further evaluation with pinpoint accuracy, at the point of care. We won’t be replaced by machines, though. The concept of augmented intelligence, which I touched on in the July 2019 issue, marries human and machine. Dermatologists will need to provide the human touch as they explain next steps to the patient based on the digital diagnoses. Speaking of which, I’d like to think we will be diagnosing and treating fewer skin cancers as the prevention message finally takes hold. The generation coming of age today grew up slathered in sunscreen and took our prevention messaging as mantra.

Teledermatology. We will see an even greater uptake of teledermatology, especially as insurers begin to see the value of this type of care and reimburse for it in a consistent fashion. Our future patients will log in for their visits from their own home, retail clinics, or primary care physicians’ offices. This will be a boon for convenience, especially in rural areas where shortages of dermatologists equal long wait times.

EMRs. As much as I hate to say it, EMRs are here to stay. We have accrued so much digital data for each of our patients that sifting through it during a visit while the patient is in front of us, hoping for answers and relief, is challenging. EMRs will become smarter and be able to spit back only the details that pertain to the visit. Just like Netflix can tell you with pretty good specificity what show you will want to binge watch based on your viewing habits, EMRs will increasingly share only the important clues.

Smart Lab Coats. Lab coats may also be smarter in the not-too-distant future. Researchers at MIT’s Wyss Institute developed smart lab coats that can detect whether the wearer has been exposed to pathogens and toxins and respond to these threats using synthetic biology. The technology can also be incorporated into gloves, body, head, and eye fabrics. The model was one of the winners of the Johnson & Johnson “Lab Coat of the Future” competition.

EBDs. Dermatologists have always had the coolest toys, namely lasers and light-based devices, and these will become more sophisticated and precise in coming years. We will be able to do more cutting with energy instead of scalpels, which will provide smoother recoveries and more accurate results.

Buckle Up

Between scientific advances, technologic advances, and augmented intelligence, I have never been more optimistic about the future of our specialty. Buckle up! It may be a bumpy ride, but it will be worth it.